Desempenho do escore de alerta precoce modificado (MEWS) na atenção primária em saúde: uma revisão sistemática da literatura

Abstract

Objective: To conduct a systematic literature review to assess the use and performance of the MEWS in unmonitored patients treated in primary care. Method: A descriptive, exploratory, quantitative approach, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, aimed to identify and critically analyze the available scientific evidence on the performance of the MEWS in PHC. The guiding question was developed based on the PICo strategy, combining controlled descriptors (MeSH, DeCS) and keywords. The descriptors included: "Clinical Deterioration"; "Early Warning Score"; "Primary Care"; "Primary Health Care." The study was conducted between January and April 2025, using a 10-year timeframe for article screening. Results: A total of 541 studies were identified, of which 11 comprised the final sample for this study. It was observed that no studies using the MEWS were conducted in Brazil or derived from Brazilian research. Other relevant and significant data were the MEWS value assigned as a cutoff, with a value of 3, consistent with the MEWS used in Brazilian hospital care and the main outcome being transfer to hospital settings. The MEWS can be used in primary care, but studies are limited, addressing its use in specific populations such as the elderly. However, these are robust studies published in journals with a high impact factor (3.6 ± 0.8/p=0.001). In studies conducted in PHC, a decrease in the mortality rate was observed (6.8 ± 1.4/p<0.0001), and the MEWS value is consistent with studies conducted in hospital care, with a cutoff of 3 (p<0.0001). The available studies on the application of the MEWS score in PHC originate from foreign countries, which highlights that this tool has not yet been applied, validated, or tested within the context of Brazilian PHC. Conclusion: Implementing the MEWS in primary health care represents a promising strategy for improving the quality of care provided at this level.